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"Ron
Brown is a certified fitness trainer who doesn't have an inch of flab on
his body. He'll tell you what you can do to become fit and trim too."
TALK
TO AMERICA, Washington DC

A
WOMAN once asked my advice concerning her loose skin,
which remained with her despite losing a great deal of excess bodyweight
following her pregnancy. I advised her to continue losing body fat until her
skin tightened up. Here is part of her angry response to my advice:

"I am disgusted with the way you responded to my question...Not only did it not make any sense, but what
you were saying was ridiculous, absurd, and physically impossible."

"...after giving birth to a baby eight months ago, and with having to let my body try and recover from gaining 87 lbs during the
pregnancy...you would think that my body would have had some changes made to
it. After a tiny 108 pound body stretches to almost double its size, you
better bet that you're going to have some major stretched skin."

"And being the 'expert' that you claim to be, you should
know this already... If someone gains a large amount of weight in a short time, or loses the large amount of weight in a even shorter
time, there will be extra skin there because it does not have the fat underneath it anymore to make the skin expand to where it was before."

"The skin cannot go back in with just dieting alone because it doesn't have
any more 'fat' underneath it to get rid of, and it doesn't have the extra layers of
fat on the body to cover anymore, so it just hangs there, left as a reminder of how fat you once were, and how much your body was forced to
stretch out to accommodate the large amount of weight that was gained. By
exercising, the skin does pull in some-with the muscle, but there will still be excess skin left on the body that
can't be 'starved off.'"

Skin Thickness
and Elasticity

Many
people would agree that this woman's argument appears to make sense. In such cases,
plastic surgery is usually offered as the best solution to eliminate
hanging remnants of excess, lax, or redundant skin, especially if the
condition is associated with skin disorders. But, a closer look reveals this logic to
be faulty. Is loose skin really unavoidable and inevitable after
substantial weight loss? I believe the answer is no!

The human integumentary system (skin) is not a passive
layer of tissue that remains stretched out like an empty plastic bag after
losing large amounts of bodyweight. The argument of the woman above about
the cause of loose skin is a
myth. Rather, skin is a living organ, actively
adapting to the body's internal and external environments. People on
extended fasts consuming nothing more than water have demonstrated that
the skin can lose 20% or more of its size.

The skin is usually thickest on the soles of the
feet, and thinnest on the eyelids. As a typical example of your skin's
thickness, pinch the skin on the back of your hand.If
it were true, as this woman claims, that the folds of skin hanging off her
body had absolutely no fat left underneath to diet away, every inch of
this skin would hang in sheets as thin as folds of paper.

However, common observation of the folds of skin in such examples reveals this
is not usually the case. Measuring the thickness of these hanging folds of skin provides
evidence that there is still a substantial amount of body fat underneath the
skin. The skin is not so much "loose" as it is flabby due to excess
body fat. Even if some
areas have completely thinned out, excess body fat is likely to be stored in adjacent areas that contribute to the overall flabby condition.

Age is claimed to be a factor that reduces
skin elasticity and thus reduces the ability of the skin to readjust it's size after weight
loss. However, many cases of loose skin are found in relatively young people who have lost
weight, so the effect of age on skin elasticity is not really a factor in all
cases, if at all.

A change in a woman's body shape before and after normal
pregnancy is another example of the skin's flexibility to snap back to
normal size. By normal pregnancy, however, I mean without large
accumulations of excess body fat, unlike the case of the woman above.

The Cause of "Loose Skin"

Why does the skin sometimes take on this hanging appearance
(e.g., abdominal pannus) during the course of losing large amounts of weight?
Why is it that not everyone who loses weight has this problem? Why do we
see flabby skin develop even in people who have lost much less weight?
What is the difference between those people who suffer from flabby or loose skin, and those who achieve weight loss while completely
or partially avoiding this problem?

In my opinion, the droopy appearance of folds of skin is most probably
caused by crash diets that sacrifice large amounts of supporting muscle, or lean body mass. Even less
severe diets and weight loss from bariatric surgery can result in a substantial amount of muscle loss over time. Perhaps
future scientific research will show a correlation between loss of lean
body mass on a diet with the development of redundant skin.

In the meanwhile, here's an example to illustrate how muscle loss on a diet can
cause droopy folds of flabby, loose skin. Let's say you start at a bodyweight of 115 pounds, in good
toned shape with firm skin,
but you gradually gain 100 pounds of body fat.
You then go on some sort of crash weight-loss program or have bariatric
surgery to quickly lose those 100 pounds.

However, let's say not all of the weight you lose is body fat.
Perhaps 20% of your lost weight is muscle. This is not unusual on a severe
crash diet, and many people lose much more muscle than that on these diets. In
fact, if you were to fast on just water, 60% of your weight loss would be
muscle.

And, because muscle can rapidly dehydrate and sacrifice protein to provide an additional supply of
energy to your body,
muscle loss increases the more active you are on a severe diet. But
let's stick to a modest number of 20% muscle loss in this example.

Now,
after your severe diet, you have returned to your starting bodyweight of 115
pounds, but your internal body composition is altered. You have 20 fewer pounds
of muscle on your body, and 20 more pounds of body fat, even though you weigh as much as you
did before you put on the extra weight! The percentage of your bodyweight that
is fat is now higher than before you gained weight.

Would you expect your body to look as
shapely and firm under these circumstances, with a higher percentage of
body fat? NO! At 115 pounds, body parts that used to be filled with toned
muscle are now filled with a greater volume of flabby fat instead. Pound
for pound, fat takes up more volume than muscle, pushing farther out until
it begins to hang
in folds of skin. Continuing on with your diet only exacerbates the problem as
your muscle level drops even more. Even worse, if your bodyweight dips
below your healthy starting point, you are now too thin and covered with
flabby skin!

Now, imagine the effect if you lose
several hundred pounds of bodyweight, and your muscle loss is twice as
much, 40-50% or more of lost bodyweight. Those voluminous folds of flab
can become an enormous problem.

Non-Surgical Removal of "Loose Skin"

To
eliminate and prevent the droopy appearance of the remnants of excess body fat
during and following
weight loss, without resorting to surgical procedures, you must
change your body composition, not just lose bodyweight. That means paying
particular attention to the ratio of your body fat to muscle, or lean body mass.
Preventing loss of
lean body mass while dieting to lose body fat will dramatically
improve your appearance.

"I lost ten pounds in one
week!" How often has the public seen such advertisements for rapid weight
loss? Everybody wants fast results. But even if you manage to lose ten pounds in
a week, the real question is what kind of pounds did you lose? Muscle? Fat?
Imagine discovering that you lost 9.5 pounds of muscle and only half a pound of
fat in one week! That's the dirty little secret of rapid weight loss claims. Now
imagine the psychological shock if you discover that after all your hard work to
take off 100 pounds this past year, you need to gain back 75 of those pounds as
muscle. The quick-fix weight loss method is not worth the effort.

Almost every dieter has
experienced rapid weight regain after dieting. Aside from regained body fat
resulting from a return to overeating habits, many people don't realize that regained
bodyweight can often include a significant amount of replenished lean body mass that was lost during dieting.
Dieters actually look and feel better—less haggard and with less droopy skin—after
regaining this kind of lean weight. So, how is muscle
lost on a diet, anyway?

During a diet a process
called gluconeogenesis (which means a
new source of glucose) utilizes muscle and body fat to supply energy not provided
by food. For each pound burned during gluconeogenesis, 60% is burned
from muscle and 40% from fat. Twenty-five percent of bodyweight lost on very-low
calorie diets (400-800 calories) is from muscle and supporting connective tissue (Saris,
"Very-low-calorie diets and sustained weight loss," Obesity
Research, 2001).

In my opinion, the best approach to avoid muscle loss
while dieting is to supply a
daily calorie intake equal to no less than your resting metabolic rate, the calories burned
by your muscle mass at rest, which is about 1,200 to 1,800 calories or higher for most people.
Professional bodybuilders have resting metabolic rates over 3,000 calories! Do
not estimate your resting metabolic rate according to your bodyweight.
Scientists have developed
formulas to calculate resting metabolic rate according to fat-free or lean body
mass levels. See The Body Fat Guideto calculate your exact resting metabolic rate according to your lean
body mass. This calorie intake, and perhaps a few hundred additional calories
depending on your activity level, is the minimum amount needed to maintain and replenish
your muscle as body fat is burned off through physical activity, much as an athlete
burns off body fat in training. You never see serious athletes like Olympic
champion Michael Phelps training while eating
only 400-800 calories! Athletes get lean by relying on exercise to burn fat while eating
enough to maintain muscle. Don't expect optimal results from sitting around and
"starving" yourself.

Dietitians suggest people
increase their activity by 500 calories a day and cut their normal calorie
intake by 500 calories. Stated more precisely, burn off body fat by
eliminating only the portion of your diet
that would otherwise fuel your usual daily activity (assuming it equals 500
calories), and burn off an additional 500
calories of body fat with additional activity, equivalent to 1-2 hours of normal
walking for most people, depending on your bodyweight. This leaves you enough food to
maintain muscle while losing two pounds of body fat a week. That's a good
deal that no quick-fix diet can match! The Body Fat Guidewill show you exactly how to do it.

Two pounds of body fat lost a week is only a
suggestion, not dogma. People have different activity levels and resting
metabolic rates. Once you understand and master dieting without muscle loss
you can customize and accelerate your training for even greater results,
provided you are willing to
put in the work. People often become motivated to work harder to achieve greater
results, but they are held back by lacking the knowledge to do it properly. For
example, many people misunderstand the advice
to exercise and cut their calorie intake by 500 calories.

Five-hundred calories
isn't very much, and people may figure they can get better results by cutting
1,000 or more calories from their diet. Sure enough, they begin to see their
weight drop rapidly when they cutback by more than 500 calories, which
reinforces their dieting behavior. But they don't understand that the suggestion
to cut their diet by 500 calories only applies to calories burned from normal
activity; it doesn't apply to the calories needed to maintain their resting
metabolic rate and muscle mass. Their rapid weight loss is mainly muscle.
When dietitians warn that severe dieting slows down your
metabolism and reduces fat loss, what they really mean is that muscle loss on a
severe diet reduces your resting metabolic rate. In the meantime, fat loss
continues as your body becomes flabbier with loose skin.

Loose skin from dieting
is not a matter of how fast or slow you lose bodyweight—it's a matter of
whether you provide sufficient calories to avoid or replenish depleted muscle. Periodically replenishing
depleted lean body mass with controlled, small increases in your calorie intake
is how you avoid an overall net loss of muscle during or after dieting.

Because a muscle's volume consists of 70% fluid, muscle
usually begins to replenish very rapidly as soon as you begin to increase your
calorie intake back

toward a normal maintenance intake amount. This
replenishment helps provide the firmness and fullness to muscle that is
lacking in flabby skin. However, you must
take extreme care to avoid over-replenishment above maintenance calorie levels, which will start increasing your
body fat level again! In effect, your dieting isn't really complete until you have
fully replenished all your muscle losses without regaining body fat.

Lean body mass replenishment can occur
in small daily amounts each dieting day. For example, on a moderate
restricted diet of
approximately 1200-1800 calories only a portion
of each dieting day is actually spent in a state of gluconeogenesis
when your
calorie intake briefly dips below your calorie
expenditures, as occurs when you are
engaged in physical activity. Muscle losses are replenished during those portions of the day when
your calorie intake briefly rises above your calorie expenditures, for
example, following a meal.

By the way, it makes absolutely no
difference when you eat your meals or engage in activity while on a diet,
because the total net difference between your calorie intake and
expenditures, known as your energy balance, will still come out the same
over the course of 24 hours. To monitor and modify your energy balance,
see The Body Fat Guide.

On
the other hand, lean body mass replenishment can also occur over several days
following a period of very strict dieting, fasting, or alternate-day fasting. For example, a person who fasts for several days is in a continuous
state of gluconeogenesis, and often follows the fast with a controlled
re-feeding period to restore healthy lean weight. Interestingly, I believe
part of the reason why more females than males develop anorexia is because
females, in general, tend to omit this
recovery of muscle from dieting, which they consider unimportant in their
drive for thinness. Generally, males are less likely to disregard replenishment of
their muscle mass. See Never Thin Enough.
I also believe that most females, including anorexia patients, are
interested in having "toned muscle." What they may not
understand is that muscle tone is maintained through adequate caloric
intake, regardless how much one exercises.

Monitoring body composition
levels of lean
body mass will guide you in determining the correct balance between your calorie
intake and calorie expenditures, which will allow you to replenish and maintain
levels of lean body mass that are burned while dieting. See The
Body Fat Guide to monitor changes in your lean body mass and body fat
levels. Experienced
dieters often take a weekly "break day" from dieting, knowing
that it recharges them. Regardless if replenishment occurs daily, every
several days, or weekly or more, failure to
restore depleted lean body mass is the number one cause of "loose skin."

It is possible to be at the ideal bodyweight according to
Body Mass Index charts (BMI), but still have too much body fat and not enough lean body mass. For example, a young woman in her twenties with
"loose skin" recently appeared on a popular radio talk show.
She had lost over two-hundred pounds in one year, and her bodyweight at 5' 8" was now in the 120's. Yet, her abdomen was covered with flabby skin that hung off of her. I would guess there is at least another 20 pounds of excess body fat stored in those folds of skin. However, if she lost another 20
pounds of bodyweight, she would obviously look like an emaciated stick!
But, that's not because she is too low in body fat...it's because she lacks
sufficient lean body
mass! My suggestion to
this young woman would be to replenish her lost lean body mass with a
healthy balanced diet, and to tone her muscle with weight training (See Muscle
Mass Myths). After increasing her bodyweight with 20 pounds of replenished lean body mass, she can then lose the rest of her excess body fat, without sacrificing any
more lean body mass. Then she would have
both a normal bodyweight AND a normal body composition.

What
is required to avoid muscle loss during a diet, and gain back lost muscle, is an easy method to measure changes in one's body composition
(muscle and body fat levels),
and a method to monitor and modify one's energy balance, which is the
balance between the calories one eats and burns each day. Such a method is
available in The Body Fat Guide.

Keeping
track of changes in your body composition using The Body Fat Guideallows you to see how much muscle you
are losing on a diet, and more importantly, it allows you to make calorie
intake changes to prevent or replenish that loss. Using the scale alone, most
dieters are unaware of their body composition changes. For example, if you start your diet
at 220 pounds with 34% body fat and end at 135 pounds with 18% body fat,
you might expect to look toned and trim after having lost 85 pounds of
bodyweight and reducing your body fat percentage almost in half, but The Body Fat Guidewill show you that you will have also lost 35 pounds of muscle in
the process, and you will probably have plenty of
flabby skin as a result! If you don't want this to happen to you, use The Body Fat Guideregularly to measure changes in your body fat and muscle levels and adjust your diet until you get
perfect results!

It may seem
counterintuitive at first to think that you need to eat more calories to
maintain the muscle and energy you need to exercise more and burn off body
fat. Why not just eat fewer calories to reduce your weight without all
that work? The answer is that you need to eat sufficient calories to
maintain your lean body mass, otherwise changes in your body composition
will not be optimal.

Here is a letter I received from another woman since first
publishing this article:

"Hi!
I've read literally hundreds of online sites regarding loose skin which seems to
inevitably accompany weight loss. Your site is the only one to list positive
news regarding this dilemma! Every other site states loose skin is unavoidable,
with post weight-loss surgery as the only solution, which of course is extremely
discouraging.

How successful is your advice; does it always work if
followed properly? I've read hundreds of personal stories at various forums and
everyone seems plagued with loose skin after weight loss. I've read your article
on loose skin and I need some further encouragement and convincing!"

It has been many years since this article on loose skin
first appeared on the web. I have received numerous positive responses from
people who have read the article and have since applied my advice. However, before presenting a
testimonial at the end of this article from a reader, here is my response to the
woman above.

Anyone who actually measures their level of body fat
(very few people know how to do that...that's where my book can help) can easily
see that, even after losing substantial amounts of bodyweight, they may still
have plenty of body fat remaining under their skin.

Perhaps you are a male who reduced from 40% body fat all
the way down to 12-18% body fat. That's an impressive amount of progress!
However, if you expect to pose for the cover of a fitness magazine, consider
that bodybuilders and male fitness models regard themselves as fat at 12-18% body fat, and usually begin
dieting down to 5% body fat or less. In a 1994 research article titled "The
lower limit of body fat in healthy active men," Friedl et al. suggested
that approximately 5.5 lbs of body fat is the minimum healthy level in
males.

There's nothing special about losing
excess body fat in "loose skin," provided you know how to properly measure
and modify your diet and activity level. But, restricting yourself to certain
foods and following unbalanced diets won't teach you how to manage that. When a person relies exclusively on an unbalanced diet to lose
weight they eventually reach a plateau due to nutritional imbalances, boredom
and cravings.

The advantage to learning how to lose weight by correctly
balancing the number of calories you eat and burn each day is that you can
adjust so many factors to keep on making
progress. You can eat
whatever you want as part of a well-balanced diet to avoid cravings and
imbalances. You can

change the speed of your loss, slower or faster as you like,
and you can exercise at a pace that suits you. If you go over your calorie
intake allowance on your diet, simply consider the extra calories as part of
your next day's allowance and get back on track without losing any time. You
have complete control and flexibility over the balance between your calorie
intake and calorie expenditures. This enables you to continue on to reach and
maintain your
weight-loss goal in a way that an unbalanced diet alone never can!

I have received letters from readers asking for
photos to prove my argument. People have become so brainwashed by
before-and-after photos that they neglect simple logic. I challenge anyone to
show me a photo of a woman with 10% body fat who has loose skin. No
one will be able to do so because a woman with 10% body fat has very little excess body fat, and
therefore she has no
"loose skin," regardless how overweight she may have once been. (Click for examples of female Hollywood
Celebrities with 10% body fat.)

So, the answer to your question is, yes, anyone can non-surgically reduce skin
folds of excess body fat, provided they follow the body
composition and energy balance numbers until the job is done right...and if anyone else doubts you and
tells you it can't be done because they didn't do it, ask to see their body
composition and energy balance numbers. After they scratch their head, you can explain it all to
them!

Of course, you can always elect to have surgery to
fix your "loose skin" problem, but consider this: First, the more you improve your
condition before surgery by natural means, the better your chance of having a
safe outcome after surgery. But, second, and more importantly, ask yourself what
is going to prevent you from regaining the weight all over again, even after
surgery? Sooner or later, you will have to deal with the root cause of your
problem, which is your inability to control your weight because you don't know
how to properly modify the balance
between the calories you eat and burn each day. There is a way to learn that...The Body Fat
Guide.

To
read a positive, unsolicited and unedited testimonial about loose skin received
from a reader in December 2004, click here.